Edema AKA: Dropsy.
is
local or general accumulation of fluid in the interstitial tissue spaces.
Edema usually occurs in
the feet, ankles, and legs, but can involve the entire body.
Edema May result from
histamine release after an injury, from a systemic pathology; heart failure, obstruction of lymphatic vessels.
Causes of Edema
- Increased permeability of the capillaries resulting from inflammation, tissue trauma, immune response, or burns.
- Obstruction of the lymphatic flow due to infection, parasites, lymphatic disease, removal of lymph nodes, radiation, scarring. Obstruction (lymphostasis) leads to retention of plasma proteins, in turn attracting more fluid. This is called low-flow high-protein edema.
- Increases capillary pressure from heart failure, thrombophlebitis, pregnancy, or general allergic response. Hot weather causing capillary dilation and sodium retention. Increased sodium retention leads to premenstrual edema. Gravity induced from prolonged standing or sitting (wheelchair).
- A decrease of plasma protein from liver and kidney disease and starvation, and burns. This causes lymphodymanic edema, a high-flow low-protein edema. Increased volume of fluid overwhelms the ability of the lymphatics to remove it.
- Edema may have more than one contributing factor; in pregnancy from increased capillary pressure and from increased fluid volume and orthostatic pressure.
- Edema resulting from acute trauma is a natural process and is part of the inflammatory response. It usually resolves when the tissue has repaired, unless fibrin laid down during the repair has obstructed the lymphatics. Lymphedema is chronic edema caused by obstruction or a pathology.
Types of Edema
Dependent: in lower or dependent body parts.
Pitting edema: when pressure is applied to the edema, an indentation is left.
Non-pitted edema: no indentation is left with applied pressure.
Primary vs. Secondary
Signs & Symptoms Acute: edema
Rubor (redness), Calor (heat), Tumor (swelling), Dolor (P), Funtio laesa (Loss of function).
Signs & Symptoms edema
Varies in temp and texture depending on cause.
Edema from trauma may go distal and appear taut/firm.
Lymphedema from surgery may not appear for weeks to years. A seemingly insignificant injury (bruise, cut, sprain, insect bite, pin prick) may provoke the lymphedema distally.
Pitted edema is boggy (caused from a chronic pathology)
Contraindications; edema
Local or distal CI’d with edema from thrombophlebitis or DVT.
H2O CI’d if infection is present.
No Distal work during acute or early sub-acute.
No full body drainage or limb elevation above the heart with chronic CHF.
Lymph drainage CI’d with untreated/metastasizing neoplasm, including melanoma.
Local lymph drainage and H2O CI’d if edema is resultant of any type of infection.
With chronic inflammation, lymph drainage should be initially performed in shorter durations and not on the site.
Parasitic infections are CI’d for lymph drainage and swedish. We don’t want to increase circulation.
No Lymph drainage with acute tuberculosis, or toxoplasmosis.
Lymph drainage on low-protein edema (kidney/liver disease, malnutrition) is ineffective. The cause is greater than Tx.
On site and distal drainage CI’d with acute and early sub-acute. Proximal Tx only.
No hot/warm H2O immediately proximal with edema caused by trauma.
Treatment Goals edema
Reduce edema if it is safe: Elevate, MLD performed before general work, Nodal pumping at terminus and proximally, stationary circles to prox nodes, prox unidirectinal effleurage.
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Treatment Goals edema late subacute and chronic
Late sub-acute: local drainage is now OK, unidirectional effleurage local and distal OK!
Chronic: Where scarring or fascial restrictions restrict lymph flow; asses for restrictions, fascial work, skin rolling, Tx prox MM for hyper tonicity.
Self Care edema
H2O is chosen for appropriate stage.
Elevation, Nodal pumping.
Diaphragmatic breathing.
Pain-free ROM and pain-free isometric exercises.
